Medical Clearance Form for Martial Arts Students
Student Information
Full Name
Date of Birth
Age
Contact Number
Address
Medical History
Are there any medical conditions or injuries the instructor should be aware of?
Current Medications
Allergies
Physician Clearance
This student is medically cleared to participate in martial arts training and related activities.
Physician's Name
Physician's Signature
Date
Parent/Guardian Name
Signature
Date